J Rheum Dis.  2016 Jun;23(3):183-186. 10.4078/jrd.2016.23.3.183.

Dermatomyositis: A Rare Extra-intestinal Manifestation of Ulcerative Colitis

• Park CH
• Myong NH
• Joo HD
• Kang MI

• KMID: 2326734
• DOI: http://doi.org/10.4078/jrd.2016.23.3.183

Abstract

Inflammatory myositis as an extra-intestinal manifestation of inflammatory bowel disease (IBD) is rare. Coexistence of immuno-mediated diseases in patients with IBD and myositis suggests a common etiopathogenic mechanism underlying these conditions. The current report refers to a rare case of a 45-year-old Korean female with ulcerative colitis (UC) who developed dermatomyositis. She presented with skin rash and proximal muscle weakness, and her disease activity of UC was in remission state. Electromyography, magnetic resonance imaging, and deltoid muscle biopsy were performed. She was diagnosed with dermatomyositis associated with UC and treatment with glucocorticoids and azathioprine resulted in improvement in muscle power and skin rash. Clinicians should be aware of this unusual extra-intestinal manifestation.

Keyword

Inflammatory bowel diseases; Ulcerative colitis; Myositis; Polymyositis

MeSH Terms

Azathioprine
Biopsy
Colitis, Ulcerative*
Deltoid Muscle
Dermatomyositis*
Electromyography
Exanthema
Female
Glucocorticoids
Glycogen Storage Disease Type VI
Humans
Inflammatory Bowel Diseases
Magnetic Resonance Imaging
Middle Aged
Muscle Weakness
Myositis
Polymyositis
Ulcer*
Azathioprine
Glucocorticoids

Figure

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  Figure 1. (A) Axial T2 weighted image with fat saturation showed bilateral symmetrical diffuse increased signal intensity in both obturator internus muscles (arrows). (B) Axial T2 weighted image with fat saturation showed epimysial accentuation of both vastus muscles with diffuse interstitial edema in the subcutaneous fat layer on both thighs.

• 

  Figure 2. Biopsy from the left deltoid muscle revealed a size variation of myofibers and multifocal lymphocyte infiltration in the perimyseal area and perivascular area. Some degenerating and regenerating myofibers are shown. There is no evidence of vasculitis (H&E, ×100).

Reference

1. Bernstein CN, Blanchard JF, Rawsthorne P, Yu N. The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol. 2001; 96:1116–22.

2. Orchard TR, Wordsworth BP, Jewell DP. Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history. Gut. 1998; 42:387–91.

3. Paoluzi OA, Crispino P, Rivera M, Iacopini F, Palladini D, Consolazio A, et al. Skeletal muscle disorders associated with inflammatory bowel diseases: occurrence of myositis in a patient with ulcerative colitis and Hashimoto's thyroi-ditis− case report and review of the literature. Int J Colorectal Dis. 2006; 21:473–7.

4. Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med. 1975; 292:344–7.

5. Oshitani H, Wakabayashi Y, Sawaguchi Y, Koike H, Yoshino Y. A case of dermatomyositis followed by multiple mononeuritis, with the history of ulcerative colitis and Basedow's disease. J Kyorin Med Soc. 1981; 12:47–53.

6. Hayashi T, Nakamura T, Kurachi K, Asai Y, Nakajima A, Suzuki S, et al. Ulcerative colitis accompanied with sarcoidosis and dermatomyositis: report of a case. Dis Colon Rectum. 2008; 51:474–6.

7. Leibowitz G, Eliakim R, Amir G, Rachmilewitz D. Dermatomyositis associated with Crohn's disease. J Clin Gastroenterol. 1994; 18:48–52.

8. Hodgson HJ, Potter BJ, Jewell DP. Immune complexes in ulcerative colitis and Crohn's disease. Clin Exp Immunol. 1977; 29:187–96.

9. Braun-Moscovici Y, Schapira D, Balbir-Gurman A, Nahir AM. Inflammatory bowel disease and myositis. Clin Rheumatol. 1999; 18:261–3.

10. Shimoyama T, Tamura Y, Sakamoto T, Inoue K. Immunemediated myositis in Crohn's disease. Muscle Nerve. 2009; 39:101–5.

11. Hayashi K, Kurisu Y, Ohshiba S, Kawamura H, Furutama D, Takada K, et al. Report of a case of Crohn's disease associated with hyper-creatine phosphokinase-emia. Jpn J Med. 1991; 30:441–5.

12. Danieli MG, Malcangi G, Palmieri C, Logullo F, Salvi A, Piani M, et al. Cyclosporin A and intravenous immunoglobulin treatment in polymyositis/dermatomyositis. Ann Rheum Dis. 2002; 61:37–41.

13. Metzger AL, Bohan A, Goldberg LS, Bluestone R, Pearson CM. Polymyositis and dermatomyositis: combined methotrexate and corticosteroid therapy. Ann Intern Med. 1974; 81:182–9.

14. Podolsky DK. Inflammatory bowel disease. N Engl J Med. 2002; 347:417–29.